When germs hitch a ride…on your scrubs


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As healthcare providers, our primary tenet is to do no harm. That should include practicing good infection control practices at all times—even when our clothes are involved.

Although the white lab coat is an ingrained part of the healthcare culture, it may carry more than pocket references and PDAs.

Nurse Rebekah: There was an article in The New York Times recently that discussed the possibility of the American Medical Association banning white coats for doctors—not because of the hypertensive possibilities of the “white coat syndrome,” but because of the risk of germ transmission. Since white coats aren’t taken home and laundered every day, these coats carry lots of really gross germs. (Though there is some debate over whether long-sleeves harbor more bacteria, the Society for Healthcare Epidemiology in America recommends recently recommended that institutions require doctors to wash their white coats at least once a week and/or provide a hook for doctors to hang the coats on prior to patient interactions).

The AMA is also considering adopting a “naked below the elbows” policy to prevent the transmission of microbes by dangling sleeves. The majority of the bloggers out there, however, seem to disagree with this proposal. The heart of their argument? The white coat bolsters the physician’s “authority” and protects the physician’s “clothes.” C’mon, ladies and gents, get over yourselves. This is about the patient, not your security blanket.

Dr. Brady: This is a good point. There are lots of downsides to the white coat for physicians as well as patients. However, there are benefits as well. In fact, the majority of patients prefer a doctor who is dressed in a white coat (though this may be changing), at least when they’re taking a questionnaire and given a number of drawings of physicians in different attire from which to choose. I’m sure, however, that if you told the same questionnaire-takers that the physicians in white coats were five or ten or however times more likely to spread germs to their patients, there would be a big change in the answers given.

Some doctors already eschew the white coat as it is. Personally, I like it, though more to protect me from germs—and for the pockets. I would be fine with changing my habits, though, as long as Rebekah doesn’t send the fashion police after me when I wear cargo pants to work.

What do you think? Is it high time to apply evidence-based medicine to the clothes we wear? Dr. Brady and Nurse Rebekah will continue their discussion of disease transmission in part III of The Perils of Beauty—and remind nurses that scrubs should be practical and professional.

Brady Pregerson, MD
Brady Pregerson, MD, a returned Peace Corps volunteer and winner of the 1995 Wise Preventive Medicine Scholarship, completed his medical school at the University of California, San Diego, and his residency at Los Angeles County General Hospital. He has authored three medical pocket books for nurses and doctors, as well as the educational web sites and Dr. Pregerson currently works as an emergency physician in Southern California. He writes, "Although the ED environment may be quite different from working on the hospital floor or in an office setting, I am hopeful that you can take these tips and apply them to your own specific work situation." You can buy his books on lessons from the ER, including Don't Try This At Home: Lessons from the Emergency Department and Think Twice: More Lessons from the ER, at

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